Sunday, June 24, 2007

Sicko

The new Michael Moore film, Sicko, is (IMHO) terrific. No doubt it contains some inaccuracies and misleading cuts (like his other films) but its overall argument is irrefutable: There is something clearly wrong with our health-care system in light of the better outcomes achieved for less money by other industrialized (and even some not so industrialized) countries. Moore's film also has the virtue of unapologetically touting a single-payer system, rather than one of the satisficing hybrids currently being proposed by Democratic Presidential candidates (although those proposals are certainly better than the status quo). He rightly describes opposition to "socialized medicine" as simple red baiting. As a practical matter, those who note that our politics won't yet embrace a universal single payer system may be right, but that's no reason not to discuss it.

The film's principal didactic flaw is its failure to explain why the U.S. system is such a disaster (although the point could be inferred by astute viewers): because so much of our health care dollar goes to administrative costs that take the form of insurance companies trying to deny coverage; a system in which everyone is covered can spend nearly every dollar on actual medical care; moreover, it does not give people incentives to skimp on preventive care which ends up costing more in the long run. Moore presents choice examples of the cruelty of the private insurance system but few good stories of its perversity.

Meanwhile, as has been widely reported, Moore is being investigated for violating the Cuba travel ban (although he says his application for permission under the exception for journalists was ignored). The travel ban is, in my view, bad policy, but not unconstitutional. However, a government decision not to process Moore's application, or a government decision to prosecute Moore, based on hostility to the content of Moore's views, would pretty clearly be a First Amendment violation. It would also be great publicity for the film, as Mark Twain surely would have noted.

12 comments:

He rightly describes opposition to "socialized medicine" as simple red baiting. As a practical matter, those who note that our politics won't yet embrace a universal single payer system may be right, but that's no reason not to discuss it.

Granted, there are folks who throw scary words out there whenever the term "single payer healthcare" comes into play (public financing certainly isn’t state-owned and operated “socialism”); however, I think it's a very legitimate position to be apprehensive about the government nationalizing healthcare (or any industry, for that matter).

Maybe I've got too much Hayek in me, but I'm philosophically opposed to a government takeover of the healthcare system, even if it only extends to financing and coverage terms. It's also probably what makes me more of a liberal than a progressive. The government has an obligation to close gaps in coverage via a strong public option, but outright state management smacks too much of central planning for my thinking. I guess to me a loose analogy is transportation – we certainly need strong public transit options, but that’s no reason to have the state eliminate the private market in cars, etc.

On top of that, health care is a very complex matter. As an example, I think there is some or a lot of truth to the argument that global pharmaceutical research thrives in large part because the United States (without price controls) creates the necessary profit stream for re-investment. Granted, too much of these funds are squandered on marketing, but I think the dynamic is there nonetheless.

Opposition to "socialized medicine" is red baiting. Worse, it is the triumph of ideology over experience. We are supposed to be a practical people, and in many ways we are, but our willful blindness to the superiority of the single payer system condems us to medical costs that are higher than necessary, and a practical denial of medical treatment to millions.

A single payer system has four virtues not available to any of the private/public hybrids proposed by the leading Democratic candidates: (1) the highest economic efficiency, (2) coverage of all, instead of almost all, Americans, (3) separation of medical coverage from the workplace, and (4) protection of the everyone, and especially the weakest, from the predators of the private health insurance industry.

Moore's cinematic style drives me nuts, but his message is right on the money.

I'm not sure why an objection to having the government run a large sector of the economy is "red-baiting" -- I doubt the U.S. ever will go Commie, but socialized medicine is characteristic of less capitalistic societies than our own. People don't notice how much health care costs until they need a lot that a third party payer isn't buying for them, but they do notice when their tax burden goes to France-like levels.

As for "a practical denial of medical treatment to millions," the long waits for non-primary case in many countries with government-run systems also works out to "a practical denial of medical treatment to millions." One of the most famous instances in bioethics was the British NHS's rationing of dialysis machines (to which Americans are guaranteed access thanks to Congressional legislation; the legend is that someone wheeled in a kidney-less person on the day of the vote), particularly to people over 65.

In favor of NHS rationing: they're very strict about handing out prescriptions to treat ED...

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